Reducing Practice to Its Essentials
Fam Pract Manag. 2002 Mar;9(3):12.
How many a poor immortal soul have I met well-nigh crushed and smothered under its load, creeping down the road of life, pushing before it a barn seventy-five feet by forty, its Augean stables never cleansed, and one hundred acres of land, tillage, mowing, pasture, and woodlot!
– Henry David Thoreau, Walden, “Economy,” Part I
If Thoreau’s picture of the farmer’s quiet desperation reminds you at all of your practice, you might be intrigued by Dr. Gordon Moore’s article in this issue (see page 25). Indeed, there’s something Thoreauvian in Moore’s practice. Where Thoreau went to live alone in a one-room cabin, Moore has gone to practice alone in a one-room office. And where Thoreau went to the woods around Walden Pond “to live deliberately, to front only the essential facts of life,” Moore went into no-staff solo practice to reduce clinical practice to its essentials. Thoreau wanted to live simply. Moore is trying to practice simply.
In making his move, Moore left behind a lot of the load you probably push before you down the road of life – receptionists, billing staff, practice administrators, payroll management, chart room, visit backlog, meetings, call sharing and the endless stream of ten-minute visits. And Moore seems to be finding, as Thoreau did, that the simpler life is, the more self-supporting it is. If you grow only the food you need, you need little enough land that you don’t need to keep oxen to plow – and that means you don’t need to work to keep the oxen fed and sheltered. Moore says his total practice expenses amount to about $1,600 per month. How does that figure compare with yours?
But is it real?
Of course, one quality Moore’s practice seems to share with Thoreau’s life in the woods is the feeling that it may somehow not quite be “real life” – that it is somehow a contained experiment. When he went off into the woods, after all, Thoreau didn’t head west in search of truly solitary life; he headed south from Concord about a mile and a half. Not so far that he couldn’t still have tea with Ralph Waldo Emerson from time to time. And he stayed for no more than a couple of years before moving back into Emerson’s house. Moore is immersed only waist-deep in his unorthodox practice, at least so far. He still holds a part-time administrative position with the group where he used to be in employed practice. And he has had the new practice for only a year – not even enough time to develop a full patient load.
I don’t mean to make light of what Moore has accomplished. For all I know, his practice will turn out to be the model for thousands of others in a few years. It’s early days yet. And even if his one-room practice turns out, like Thoreau’s one-room hut, to be little more than an incubator for ideas, its value may still be incalculable. If he can help to demonstrate that some of the assumptions underlying typical practice today are unfounded, he will have opened one of the doors to tomorrow.
ERROR REDUCTION: CALL FOR MANUSCRIPTS, TIPS AND TOOLS
Family Practice Management is planning a special issue on error reduction in family practice, and we could use your help. We’re looking for article submissions that can help family physicians reduce various kinds of errors within their practices. We’re looking for tips from family practices that have successfully developed systems for catching or preventing errors. And we’re looking for tools that can make error reduction easier in everyday practice. If you think you can help, please let me know by e-mail at email@example.com or by fax at 913-906-6010.
Copyright © 2002 by the American Academy of Family Physicians.
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